Multimethod Analysis of Potential Disease Intervention Career Pathways at US Undergraduate Institutions

Quantitative Approach

For the quantitative component of this study, we drew on the 2021 and 2024 PH WINS data to generate a baseline (ie, pre–CDI launch) understanding of DIS-specific educational backgrounds. PH WINS is a nationally representative survey that characterizes individual workers in state and local health departments. We used job classification and educational attainment survey items to describe the educational background of those employed as DISs in local and state health agencies. Our sample included 2577 individuals who indicated “disease intervention specialist/contact tracer” as the role that best aligns with their work.

Participants reported their educational attainment by indicating degrees and certifications attained. We assessed the proportion of those with a bachelor’s degree or higher when considering formal degrees. In reporting certifications, participants selected options from a list reflecting common certifications (eg, physician board certification, nurse certification, certified community health worker) and/or could select the “other” option, which provided space for naming this other certification. We developed search parameters based on our literature review and CDI examination content to describe these “other” certifications and whether they aligned with DIS skills. Search queries scanned and initially classified the text, and then we confirmed the appropriateness of the classifications. If participants reported having a DIS-specific certification (eg, disease intervention specialist), they were classified as DIS certified. The research team categorized those with certifications that aligned with 1 or more of the other DIS-related terms as having DIS-related other certificates. We used Microsoft Excel and Stata version 18.5 (StataCorp) for these analyses.

Qualitative Approach

We conducted listening sessions with representatives from undergraduate-serving institutions. To recruit participants, we used ASPPH’s institutional research and National Center for Education Statistics (NCES) Integrated Postsecondary Education Data System (IPEDS) data ²³ to identify US schools and programs offering undergraduate public health majors. With ASPPH guidance, we selected recruitment representatives from undergraduate institutions that varied in geography, CEPH accreditation, and minority-serving institution (eg, Historically Black Colleges and Universities, Tribal Colleges and Universities, Hispanic-serving institutions) status.^24,25 The participants were typically undergraduate public health program directors and/or faculty who taught undergraduate public health courses. In addition to this purposeful sampling, other participants were recruited using snowball sampling. ASPPH and CPHS distributed invitations via email and included details on the study, a $25 gift card incentive, and a scheduling link. Interested individuals scheduled a session time and received 2 subsequent reminder emails and an information sheet from CPHS before their session.

Listening sessions occurred from January through March 2025. We used a semistructured guide to facilitate discussion intended to gather exploratory perspectives on potential DIS pathways. Participants discussed perceptions of their institution’s resources for undergraduate students and feasibility of implementing CDI pathways. Listening sessions were neither recorded nor transcribed at the request of our funder. Informed consent was verbally provided by all parties involved in listening sessions. Therefore, to increase rigor, at least 2 project team members took notes during each session and conducted postsession debriefs to compare notes. Two members of the research team (C.K., G.L.) collated and analyzed all notes using inductive and deductive coding. ²⁶ Inductive coding consisted of descriptive coding and thematic analysis.^27,28 We organized results into themes. We completed all analyses using NVivo version 14 (Lumivero). After all listening sessions were completed, participants received a $25 gift card as a thank you for completing a listening session.

Quantitative Findings

Our analytic sample included 2577 participants from the 2021 and 2024 PH WINS who identified as DISs. Among DISs, a weighted estimate of 74.5% and 81.6% reported having a bachelor’s degree or higher in 2021 and 2024, respectively. Approximately half (53.2%) of the combined sample reported having at least 1 certification; the most commonly reported certificates were clinical certifications (23.7%) and “other” certifications (16.7%) (Table 1). Fewer than 1% of DISs (0.7%) reported having a DIS-specific certification (ie, training resulting in a certification in disease intervention or similar). Among DISs with any certification, 39.5% also had a bachelor’s degree or higher, which was substantially more than participants without at least 1 certification (37.4%).

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Table 1.

Certifications among disease intervention professionals in the 2021 and 2024 Public Health Workforce Interests and Needs Survey (N = 2577) ^a

Certification class	Certification name	Certification detail	No. (unweighted %)	Weighted %
Formal	Community Health Worker	—	66 (2.6)	2.1
	Certified Public Health	—	41 (1.6)	1.4
	Certified Health Educator/Master Certified Health Educator	—	44 (1.3)	1.6
	Diabetes Educator	—	4 (0.2)	0
	Lactation	—	8 (0.3)	0
	Food Safety/Outbreak Investigation	—	6 (0.4)	0
	Infection Control	—	22 (0.9)	1.3
	Clinical Certification	Board-certified physician, public health dentist, nurse	611 (23.7)	23.4
	Multiple formal certification	Any combination of 2 or more certifications meeting the above criteria	139 (5.4)	5.6
	Total	Any of the above	941 (36.5)	35.4
Other certificates	Total	Includes unspecified “other” certifications and non–DI-relevant certifications	431 (16.7)	16.7
Other DI-specific	Disease intervention specialist	DIS, disease intervention specialist	19 (0.7)	0.8
Other—DI-relevant	Epidemiology	Field epidemiology, CDC epidemic intelligence	5 (0.2)	0.3
	Contact tracer	Contact tracer, community contact tracing trng [sic] certificate of completion	13 (0.5)	0.3
	Phlebotomy	Phlebotomist, certified phlebotomy technician	36 (1.4)	1.1
	STI/STD/HIV	Certified HIV test counselor, HIV PrEP navigator	7 (0.3)	0.3
	COVID-19	COVID-19 contact tracing Johns Hopkins, COVID-19 contact tracer	13 (0.5)	0.4
	Multiple other certifications listed	Any combination of 2 or more certifications meeting the above criteria	3 (0.1)	0.1
	Total	—	96 (3.7)	3.7
Any certification	—	—	1372 (53.2)	52.9
No certification	—	—	1205 (46.8)	47.1
Total	—	—	2577 (100.0)	100.0

Abbreviations: CDC, Centers for Disease Control and Prevention; DI, disease intervention; PrEP, preexposure prophylaxis; STD, sexually transmitted disease; STI, sexually transmitted infection.

a

Data sources: Robins M et al.^21,22

Listening Session Findings

We conducted 11 voluntary listening sessions with representatives from 11 undergraduate institutions (15 participants total) (Table 2). We organized results into 6 themes across 2 overarching domains: (1) barriers and facilitators and (2) feasibility of establishing CDI pathways.

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Table 2.

Characteristics of undergraduate public health institutions represented among participants (n = 11) in listening sessions describing undergraduate pathways to disease intervention careers, United States, 2025

Qualitative interview characteristics	No. of interviewed institutions
Location
Northeast	4
Southeast	3
Midwest	3
West	1
Type of institution
Public	8
Private	3
CEPH accreditation
Accredited school of public health	7
Accredited program	1
Accredited bachelor’s program	1
No accreditation	2
Confers public health bachelor’s degrees
Yes	10
No	1

Abbreviation: CEPH, Council on Education for Public Health.

The first domain, barriers and facilitators, included 2 themes. The first theme focused on alignment between CDI domains and institutions’ course offerings. Participants discussed how curricula aligned with CDI domains; participants from institutions with greater overlap expressed more optimism about implementing undergraduate DIS pathways than those with less overlap. However, most participants hesitated to confirm alignment because NBPHE and national partners had not yet finalized detailed definitions of domains and experiential learning requirements. The CDI domain Collaboration was consistently reported as covered, often integrated across multiple courses. Coverage of the CDI domain Field Services and Outreach varied. Reported coverage of the CDI domains Interviewing and Case Management Activities, Outbreak Response, and Emergency Management ranged from partial coverage to unknown or no coverage. Participants rarely mentioned curricula incorporating the CDI domain Planning and Case Analysis. The CDI domain Surveillance and Data Collection was most often found in epidemiology-focused programs. All participants reported experiential learning within programs. Requirements varied widely, from a 50-hour volunteer practicum to a 140-hour internship in placement sites including health departments, nonprofit organizations, hospitals, and state agencies. Barriers to these DI-related work experiences included difficulty securing host sites, limited paid opportunities, and privacy and safety concerns. Nine participants noted general overlap with existing curricula, particularly in epidemiology courses.

The second theme in the Barriers and Facilitators domain addressed student and faculty interest. Some participants anticipated strong student interest in DIS pathways, while others expected little student interest. Participants reported faculty engagement as critical for success. At some institutions, participants indicated that faculty could be amenable to providing examination preparation and supplemental coursework, whereas other participants anticipated minimal involvement.

The second domain, Feasibility of Establishing CDI Pathways, included 2 themes. The first theme, institutional capacity, focused on partnerships and funding. Participants described challenges forming partnerships with external organizations, particularly in geographically isolated areas or where institutions lacked capacity to manage internships, even when agencies wished to collaborate. Participants mentioned past alumni donations and grants as potential funding sources. One participant reported having no funding streams that could support a DIS pathway. Participants reported that institutional capacity paralleled alignment with existing curricula, as discussed in the first domain.

The second theme in the Feasibility domain addressed recruitment considerations. Participants suggested targeting students interested in health fields and promoting CDI credentials as complementing existing degrees. They described students learning about public health through peers or after changing their degree paths. Participants described recruitment strategies that included outreach to students in nursing, premedicine, exercise science, and health education programs and building connections with communities served by DISs. Some participants proposed recruiting from high schools through expanded programming and dual-credit opportunities. Despite enthusiasm for recruitment, participants acknowledged challenges such as limited institutional involvement due to structural constraints, lack of funding, degree timing–related constraints for DI training, and concerns about promoting pathways that lacked financial support and known career trajectories.

Limitations

This study had several limitations. First, listening session participants represented a small and potentially nonrepresentative sample of US undergraduate institutions that may not reflect the full diversity of institutional capacities or student interests. Second, the qualitative data also reflect a single point in time, prior to the launch of the CDI credential. Perspectives may evolve as institutions gain familiarity with certification requirements. Third, although the PH WINS analysis offered valuable national data, limitations are inherent in survey research, including potential nonresponse bias. Fourth, the classification of DISs likely overrepresents individuals hired as contact tracers during the COVID-19 pandemic in 2021 when demand was highest for these roles and may underrepresent workers performing DIS functions under other titles. Finally, our method for identifying DIS-related certifications relied on textual responses and may have introduced further misclassification, because many participants who reported “other” certifications were neither standardized nor elaborated upon in text responses.